Advance Directives Help with End-of-life Decisions

“You need two witnesses for a living will. One witness may be your spouse or a blood relative. The other witness needs to be someone who is not related to you,” says Karen Washburn, director, Palliative Care Services.

Planning ahead for health issues alleviates confusion, especially when the patient is
too ill to relay his or her wishes. Advance directives give the patient a voice, especially
when the outcome could mean the difference in life and death.

Advance directives give medical personnel specific instructions on the extent of
lifesaving measures the patient wants when that person cannot speak. Advance
directives serve as a guideline for physicians and other people who are directly involved
in your care, says Karen Washburn, director, Palliative Care Services. They speak
when you cannot and help make difficult decisions easier for family members who may
not know what you want.

A physician who believes a patient is in a life-threatening situation consults another
physician for a second opinion. If both believe that the patient has a terminal condition,
end-stage condition or is in a persistent vegetative state, they will consult the advance
directive to make a decision based on the patient s wishes. A living will is the part of the
advance directive that helps physicians understand the extent to which a patient wants
lifesaving care when he or she is unable to continue to make decisions.

You need two witnesses for a living will, Karen says. One witness may be your spouse
or a blood relative. The other witness needs to be someone who is not related to you.
Another part of a living will is the Designation of Health Care Surrogate (DHCS),
which allows a patient to appoint another person to make health care decisions for him
or her. The DHCS does not have to be a blood relative.

Cynthia Brasher, system director, Spiritual Services, says the advance directive helps
her team minister to the patient and the family members who are dealing with end-
of-life issues. Family members know that the decision was made by the patient, she
says. This helps, especially if family members have different opinions on the best care
for the person they love, and empowers them to honor and protect their loved one s
wishes.

Advance directives may be written or given through verbal instructions to a physician.
They also can be changed at the patient s request. The important thing for patients
to know is that they can be in control of their care, Cynthia says. You don t need an
attorney to create an advance directive and you can change it. We want you to make
decisions about your health and the advance directive allows you to do that, even if you
reach a point where you can no longer speak for yourself.